Biomedical subjects

T M Zizic

Publications and source records attributed to T M Zizic.

10 recordsLinked to original sources

PubMed1991

Osteonecrosis.

Osteochondritis dissecans has been shown to heal with protective weight bearing alone, if there is no loose body in the joint. Magnetic resonance imaging can accurately predict the presence and extent of chondral fragments, and it appears that a magnetic resonance staging classification has been developed that allows preoperative staging of lesions of the talus and the knee. In a large study of hip dislocations, the most important predeterminant of poor clinical outcome was the presence of avascular necrosis. In addition to stigmata of rheumatoid arthritis, recognizable in 90% of 107 femoral heads in rheumatoid arthritis patients, 29 heads (28%) had intracapital trabecular fractures that were either the sole feature or a very important feature of the histopathology. In systemic lupus erythematosus patients the mean maximal daily dose of prednisone was significantly greater in patients with osteonecrosis than in those without bony complications. A novel canine model allowing investigations into the pharmacologic regulation of circulation in bone is discussed along with the first demonstration in humans of a pharmacologically produced decrease in bone marrow pressure. In spontaneous osteonecrosis of the knee, patients with magnetic resonance abnormalities on T2-weighted images have a poor clinical outcome. Magnetic resonance imaging of the hip can provide images of equal resolution in any plane, which is helpful in evaluating the extent and location of femoral head involvement. A large study revealed that total joint replacement should be done judiciously in osteonecrosis, because there is a 37% overall failure rate as compared to 10% failure rate in total hip replacements done for other causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Vascular lesions in SLE.

The confusing array of manifestations resulting from multisystem involvement in SLE is due, in part, to the widespread involvement of blood vessels.

Humans↗

PubMed1978

Antibodies to type II collagen in relapsing polychondritis.

Relapsing polychondritis is a disorder of unknown cause characterized by the destruction of cartilage. To test the hypothesis that immunologic mechanisms are involved in the pathogenesis of relapsing polychondritis, we analyzed the serum of 15 patients for the presence of antibodies to cartilage. Antibodies to Type II (cartilage) collagen were found in the serum of five patients at the time of acute symptoms. No antibodies were detected either to cartilage proteoglycan or to other collagen types. The antibodies were detected at the onset of the disease and their titers appeared to correlate with severity of disease. Circulating immune complexes were also detected in the serum of these patients. Our findings support an immunologic involvement in this condition.

Acute Disease↗

PubMed1977

The pseudothrombophlebitis syndrome.

Sixty-two patients with popliteal or calf synovial cysts defined by arthrography are presented, of whom 34 had the pseudothrombophlebitis (PTP) syndrome. While the clinical manifestations of PTP may closely mimic thrombophlebitis, including the presence of calf pain, swelling and warmth, and a positive Homans' sign, the helpful descriminating features include the presence of inflammatory joint disease (91%), concomitant pain and swelling of the knee (94%), a demonstrable knee effusion (91%) and the absence of deep venous tenderness or cord. Except for seven patients with large intact Baker's cysts, the PTP syndrome was associated with synovial cyst dissection (18 patients), rupture (5 patients), or both (4 patients). Of those with arthrographically demonstrated Baker's cysts, only 27 (44%) had a palpable mass in the popliteal fossa and another 4 (12%) a mass in the calf. Popliteal fossa pain was noted in 22 (35%). Thus, clinical features are far less sensitive than arthrography in the diagnoses of both synovial cysts and pseudothrombophlebitis. Among patients with rheumatoid arthritis there were no differences in the severity or duration of disease or the extra-articular features in patients with and without synovial custs or the PTP syndrome. The therapeutic implications of pseudothrombophlebitis are of major significance with respect to the avoidance of anti-coagulation and the prompt response to intra-articular corticosteroids. Possible mechanisms of synovial cyst formation and unusual presentations of synovial cysts are discussed, and the literature is reviewed.

Arthritis, Rheumatoid↗

PubMed1976

Ischemic necrosis of bone in systemic lupus erythematosus.

Twenty-three patients with systemic lupus erythematosus (SLE) and ischemic bone necrosis are reported. All patients had received corticosteroids prior to the onset of ischemic necrosis, although one patient had received none for 13 years previously. Nineteen (83%) patients had multiple bone lesions including the femoral heads in 21 (91%) which were bilaterally involved in 15. In addition, humeral heads were affected in seven patients and the tibial plateaus, in three. The most striking feature of this group was the high incidence of Raynaud's phenomemon present in 14 (61%) of the 23 patients. Furthermore, central nervous system involvement was present in 10 (43%) patients, more prominent in those without Raynaud's (67%) than in those with vasospasm (29%). Thus, 20 of the 23 patients, or 87%, evidenced vascular abnormalities either in the form of Raynaud's phenomenon and/or systemic vasculitis. The pathogenesis of ischemic bone necrosis is discussed. In SLE, vasospasm or vasculitis, or both, augmented by corticosteroid therapy, could impede the microcirculation and result in the ischemic lesion.

Adult↗

PubMed1976

Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum, and relationship to other features of the disease.

1. Among patients with SLE, 71 (51%) had significant neuropsychiatric problems during the course of the disease. In 52 (37%), the nervous system manifestations were secondary to SLE. 2. The most frequent manifestations were psychiatric dysfunction, seizures, long tract signs, cranial neuropathy, and peripheral neuropathy. 3. Psychiatric abnormalities secondary to SLE were characterized by organic features (present in 22 of 24) and by the association of neurologic lesions which were often diffuse or multifocal. 4. An abnormal cerebrospinal fluid was found in 32% of neuropsychiatric episodes in which specimens were obtained. The most frequently abnormal study was the electroencephalogram (71%), and the least frequent was the brain scan (8%). These studies did not correlate with specific clinical patterns. 5. In 63% of the patients, NP manifestations preceded the diagnosis of SLE or occurred within the first year of diagnosed disease, and in most episodes were associated with evidence of clinical and/or serologic activity of the underlying illness. 6. Only two clinical features showed significant and striking correlations with neuropsychiatric involvement, namely vasculitis and thrombocytopenia. The possible pathogenic implications have been discussed. 7. Only 2 of the 140 patients were felt to have steroid-induced psychoses. In approximately one-half of the NP episodes secondary to SLE, patients were receiving no corticosteriods on presentation. Of those developing while patients were on steroids, the majority occurred on low doses or after tapering from higher levels. 8. The immediate prognosis for improvement in neuropsychiatric function was good with 84% of episodes showing complete or partial resolution. Corticosteroids appeared to be of benefit in a substantial number of patients although their precise role is difficult to quantitate. 9. Five and 10 years survivals for the overall population were 94% and 82%, respectively. There were no significant differences in survival for patients with or without nervous system involvement.

Adolescent↗

PubMed1976

Urinary fibrin split products in lupus nephritis.

Antigen-antibody interaction and fibrin deposition at the glomerular basement membrane can release activators that ultimately convert fibrin into degradation products of varying molecular size. Thus, increased urinary fibrinogen/fibrin split products (FSP) might be expected in active lupus nephritis. A longitudinal study was done on 27 patients with biopsy-proven lupus nephritis. Those patients who were persistent FSP excretors were found to be at a significantly greater risk of progressive nephritis and renal death than those who were FSP negative. It is suggested that FSP excretion in lupus nephritis, particularly on a continued basis and despite normalization of other renal disease parameters, is a grave prognostic sign.

Antigen-Antibody Complex↗

PubMed1975

Colonic perforations in systemic lupus erythematosus.

Five patients with systemic lupus erythematosus (SLE), four of whom died with colonic perforations, are reported. Perforation of the colon constituted the most frequent cause of death among 107 patients with SLE admitted to the Rheumatic Disease Unit during a three year period. All five patients with colonic perforation had clinical and laboratory manifestations of active SLE in addition to the abdominal syndrome. Most striking was evidence of active arteritis in all patients with either central nervous system involvement and/or peripheral arteritis, in addition to that found in the gastrointestinal tract. Hyperglobulinemia and rheumatoid factor as well as antinuclear antibodies were present at some time in all patients. The abdominal syndrome was characterized by the insidious onset of lower quadrant pain which was intermittent and colicky. Although direct abdominal tenderness was eventually present in all patients, rebound tenderness and hypoactive bowel sounds were variable and abdominal rigidity occurred only in one patient and late in the course. The differential diagnosis of abdominal pain in SLE is reviewed and possible mechanisms for the production of colonic perforations are discussed. It is suggested that the presence of rheumatoid factors in conjunction with circulating immune complexes may be the pathogenetic mechanism via the production of a mesenteric arteritis.

Adrenal Cortex Hormones↗

PubMed1975

The arthropathy of Behçet's disease.

Behçet's disease, originally described as a triad of ocular inflammation and oral and genital ulcerations, is better understood as a mulitsystem disease involving skin, joints, central nervous system, large bowel, and peripheral veins. This report of a 49-year-old female patient with uveitis and recurrent orogenital lesions, polyarthritis, and skin lesions, serves as introduction to a review of articular involvement in Behçet's disease. Included is complete synovial fluid analysis with measurement of intraarticular complement. Arthropathy, occurring in at least one-half of reported patients, is usually polyarticular and asymmetrical. It affects knees and ankles most frequently and rarely produces loss of function or deformity. During exacerbations synovial fluid appears inflammatory with polymorphonuclear leukocytosis greater than 25,000 cells/mul; synovial fluid complement is consistently elevated. Histologically the synovium shows increased vascularity with perivascular lymphocyte infiltration. Etiology and treatment of Behçet's disease are briefly discussed.

Arthritis↗

PubMedDate not supplied

Alcoholism associated ischemic necrosis of the femoral head. Early diagnosis and treatment.

Thirty-eight hips in 26 patients with alcoholism associated ischemic necrosis of the femoral head (INFH) have been evaluated by measurement of intraosseous pressure, (IOP) pressure response to a 5 ml saline load injected intraosseously and intraosseous venography. All stages of INFH were characterized by elevated IOP and/or an increased pressure response to the saline load compared to normal controls. Intraosseous venography in INFH was characterized by poor or absent visualization of the main efferent veins draining the proximal femur, diaphyseal reflux and delayed evacuation of dye from the bone. It has been possible to identify both a preradiologic and even preclinical stage of INFH. Core decompression, the removal of an 11 mm plug of bone from the head and neck of the femur, has been carried out on all hips in the study. All patients had pain prior to surgery. Eight patients in Stage I (preradiologic stage) are symptom free and without radiologic progression at follow-up, average 24 months. Only one of 5 patients in Stage II (no collapse of the femoral head) has shown X-ray progression while all remain asymptomatic. In Stage III (collapse, without acetabular involvement), core decompression offers relief of symptoms but does not appear to prevent further head collapse.

Adult↗